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S4 prescribing

Discussion in 'Australia' started by jos, Jun 21, 2007.

  1. Tuckersm

    Tuckersm Well-Known Member

    The 14 hours will be likely run by LaTrobe within the next few months (dates will be confirmed this week and included in a Board newsletter to be sent out next week), restricted to those with the current qualification and experience. For those going down the mentor pathway, further negotiations with various health services will need to occur to allow for the "placements"

    For those without any pharmacology training, the approved course could come from a number of providers, as the requirements are similar as those for nurse practicioners, so those units or the current LaTrobe course units are likely to be suitable.

    LLF is correct about what a session will be
     
  2. MrBen

    MrBen Active Member

    and idea when this might flow on to other states? National registration is due next year if im not mistaken
     
  3. Paul Bowles

    Paul Bowles Well-Known Member

    It wont really "flow on" as each state is governed by its state laws with regards to prescription of scheduled drugs.

    I doubt Victoria obtaining rights will have any initial impact on other states, however it does set an excellent precedent to develop state blueprints to go by.
     
  4. Tuckersm

    Tuckersm Well-Known Member

    Mr Ben,

    Paul is correct. Access to restricted medicines is controlled by state poisons acts, so despite national registration, will require local lobbying to have state rugs and poisons laws ammended.

    Also the Podiatry Registration Board of Victoria has posted a newsletter on its website (to be sent out to all Vic Reg Podiatrists next week) further outlining the process to endorsment.
     
    Last edited: Jul 15, 2009
  5. JosephFrenkel

    JosephFrenkel Member

    This is all very exciting!
     
  6. Tuckersm

    Tuckersm Well-Known Member

    The Registration Board has further updated its website with information on applying for endorsement including the forms that need to be completed.
     
  7. tracyd123

    tracyd123 Member

    Hi Everyone

    I was wondering if the 7 years clinical experience in a hospital setting can be substituted for experience in a community health setting?

    I work in community health and see predominantly high risk clients, attend to wounds regularly and conduct nail surgeries etc.

    Also I heard a rumour that supervision can be conducted by an experienced dentist instead of medical practitioner, does anyone know if this is true?

    And yet another question…. When are the proposed case studies going to be available and where are they to be found??

    Thanks

    Tracy
     
  8. Paul Bowles

    Paul Bowles Well-Known Member

    This is a really interesting question - but more broadly it is interesting that a statement like this is included in the Boards requirements.

    This would preclude nearly all private based Podiatrists from applying for this criteria. However on the flip side it will allow Podiatric Surgeons instant access to fulfilling this criteria (funny that!).

    Personally I would have thought criteria would more have been focused on educational requirements and mentoring rather than direct supervision - as most Podiatrists around the country (let alone Victoria) would not work in a public health setting.

    I am yet to thoroughly read through the rest of the document however I am sure things will require changing as time passes to refine the regulations and changes.

    I too would be interested in Stephens response to the above question...
     
  9. Tuckersm

    Tuckersm Well-Known Member

    Tracy, it is not about general experience or experience with wounds, but experience in a precribing environment, hence hospital experience and the need for two referees, who must be able to prescribe the drugs on the podiatry formulary, and treat the podiatric conditions, so only medical practicioners initially, then precribing pods. All updates and info will be on the board website as it becomes available.

    And Paul, things will probably develop and change overtime. And yes Pod surgeons will meet the crieria quite easily as will many of the pods currenly working in hospital based high risk foot clinics (5-10% of Victorian pods). I am sure that programs will be put in place to allow other pods to gain the required experience in hospital settings.
     
  10. tracyd123

    tracyd123 Member

    Thanks Stephen, however I may be a tad ignorant but what exactly is a prescribing environment? Are the pods working in a high risk clinic directly seeing the specialists prescribe?

    Can I have further clarification on this?
     
  11. Tuckersm

    Tuckersm Well-Known Member

    Tracy, from my experience the assessment and prescribtion of antibiotics often occurs as a joint consult. eg; pod identifies need for drugs, finds either consultant, or registrar, explains issues, and will then co consult with patient, with the drug then being chosen and prescribed. In cases where the medical staff may be more junior or less accustomed to foot wounds, direct advise on what to prescibe is asked for.
     
  12. LuckyLisfranc

    LuckyLisfranc Well-Known Member

    Stephen

    I am a little suprised that the Board didn't recognise possible pathways for the 80-90% of podiatrists that work in primary health care...(eg get on the phone to local GP (or speak to the one down the corridor in your medical centre), discuss case, recommend appropriate therapy).

    Having worked in both primary and tertiary settings, there is often really no difference when it comes to the 'prescribing environment' for comon foot conditions. Its just not quite as 'fluid' as a public hospital multidisciplinary clinic.

    Perhaps a primary care pathway is called for also?

    LL
     
  13. Tuckersm

    Tuckersm Well-Known Member

    The Board looked at many options, and this is what was acceptable to all those in the approval chain.
     
  14. Paul Bowles

    Paul Bowles Well-Known Member

    Interestingly enough the Victorian Board is headed up by a Pod Surgeon. It is made up of another 3 practitioner members who all work in Public Health and the final practitioner member owns a practice who employs a Pod Surgeon.

    It's no surprise really that this was recommended with a Board made up of people with backgrounds such as this.

    However, I am still gobsmacked that all this work went into this and it will only be attainable by 5% of Victorian Podiatrists?

    I totally agree with Tony on this one - my experience in Public Sector, Private Practice, Academia, Policy Formulation and Podiatric Surgery tells me that we have a wealth of capable practitioners out there in all Podiatric sectors - Primary Care pathways are a no brainer really. Why is the Board limiting advancement of the profession to a small corner of the Podiatric Medical market; Namely - Pod Surgeons and a handful of Public Sector Podiatrists (who lets face it most likely have the network to get these drugs on request anyhow with the click of a finger).

    So that means 3 Pod Surgeons in Victoria, and (I would guess) under 10 Public Sector Pods may get S4 rights in the near future?

    Sorry to be so negative about this, but having been working on S4 rights in NSW for over 5 years this initial excitement for Victorians and all the hard work that has been done by them is turning into a feeling of extreme sorrow - to hear that it came from recommendations of one of our own Boards is even worse!

    What did I expect? I don't really know. Some flowers? Expensive french champagne? Fireworks going off in celebration? Podiatrists dancing in the streets? Maybe I expected a little to much, or maybe I should get used to the fact that if we as a Profession are so heavily scrutinized for the routine things we do - that maybe we just shouldn't be doing them at all!

    I am still to read through the whole document thoroughly, but on the surface it appears as though it may be one step forward and two steps back!

    Take note other states...your time will come!
     
    Last edited: Jul 29, 2009
  15. Nat Smith

    Nat Smith Active Member

    I just received the newsletter from the Board and am also quite surprised at the difficulties posed for pods in the private sector. I have no issues with the extra study required, having graduated before 2003, I'm happy to attend classes & do all the requisite theory to gain the appropriate level of education - 78 hrs of lecture based content & up to 150 hrs of non-lecture content. But how are we supposed to satisfy the criteria of 7 yrs hospital setting experience? Are all private pods supposed to suddenly take time out of their busy practices and compete for a few part-time public health positions so we can get our required hours? 40 sessions of 4 hours (160 hours) within a 12mth period. Not very practical. We've fought so long and hard for what exactly?
     
  16. Tuckersm

    Tuckersm Well-Known Member

    Paul,
    As I said earlier this was the proposal acceptable to ALL in the approval chain, which included the Podiatry Prescribing Advisory Committee, the Reg Board, The Department of Human Services, external consultations (including with the AMA, college of GPs), The DHS Health Professions Drug Access Committee, the Minister for Health and his own advisors, so why what we have is not ideal, it is what we have.

    And Paul, it has taken Victoria 13 years to get to this stage, and it has been 4 years since the legislation passed Parliament, and 2 years since it has been law.
     
    Last edited: Jul 30, 2009
  17. ClintonAbel

    ClintonAbel Active Member

    The process does not seem to fit two of the major public policy objectives. Those being; 1 to reducing the backflow burden to GP's and other prescribers, and 2 reduce the time delays in patients receiving appropriate treatment.
     
  18. Tuckersm

    Tuckersm Well-Known Member

    Clinton,
    The first objective is to be safe, and the process agreed is that which the bureaucrats believe will make for safe prescribing by podiatrists. The process that is in place is similar to the process for Nurse Practitioners in Victoria. So it is what we have to work with.
    It is only 20 days of supervised practice, and so once you have met the criteria to be endorsed, the other objectives will be met.
     
  19. ClintonAbel

    ClintonAbel Active Member

    Stephen,
    That's great. Lets hope the other states can move forward as Victoria has. Hopefully learning some very valuable lessons along the way. Of course safe prescribing is obviously paramount.
     
  20. Tuckersm

    Tuckersm Well-Known Member

    Nat,

    Only if you wish to be endorsed. It is not compulsory.
    If your practice is so busy, and you can't afford half a day a week for 10 months, and then 30 hours a year to maintain endorsement, maybe prescribing restricted medicines is not for you!
     
  21. Paul Bowles

    Paul Bowles Well-Known Member

    Thanks.

    Fair point. I know its been a long, difficult process for those involved, if Victorian Podiatrists are happy with this then more power to them! I agree it is not a huge amount of things to do when it comes to prescribing rights and if it is managed correctly and fairly giving opportunity to Podiatrists to actually complete the supervised hours then I am all for it in principal.

    My biggest issue would come if/when Podiatrists cannot get into positions enabling this supervision. Then the system becomes unfair and biased - and in my personal opinion utterly pointless. I will be interested to see how it is rolled out.

    Well aware of that Stephen - its been a long road for those involved, but a successful outcome none the less.
     
  22. Tuckersm

    Tuckersm Well-Known Member

    Paul it is hoped that once we have a number of endorsed podiatrists, the number of places for pods to gain experience will expand. They may not all be paid placements, but will hopefully meet the demand.
    Some of the initial options for "placement" include , Vascular clinics, HRFCs, Endo Clinics as well as ED and soon Hospital Podiatry clinics, wards rounds would be included etc. The first stumbling block will be to attract willing medical supervisors, given the complete lack of support for podiatry prescribing from the AMA.
     
  23. Nat Smith

    Nat Smith Active Member

    Stephen,
    As I mentioned, the extra study or work required to obtain endorsement is not my issue. I don't particularly care if it's a paid position or volunteer hours to get the required experience for endorsement. I'd happily take on a public position for the half day a week...but how many positions are there available for private pods to suddenly enter the workforce? My issue, as Paul mentions above, is one of access. All qualified podiatrists should have the opportunity and a pathway of training available for all to achieve the same level of endorsement.
     
  24. Tuckersm

    Tuckersm Well-Known Member

    Nat, I think this is one for the Pod Association. They should be liasing now with DHS to ensure suitable arrangements can be put in place within hospitals to provide placement opportunities.
     
  25. Paul Bowles

    Paul Bowles Well-Known Member

    Thats the answer from the Registration Board I was afraid of Stephen!

    It's sort of like saying we will rely on the ACPS to train Pod Surgeons. We all know how well that has turned out. I can count the number of fellows the ACPS has managed to graduate in the past 10 years on three fingers of my left hand!

    Stephen the ACPS has/had a similar mentality to "on the job medical training" for its registrars. Basically they were told to go find a placement...In NSW no public facility would accommodate that for several obvious reasons. If the "placements" are not officially set up and recognized/organized by the relevant Registration Boards there is no shiny hope in hell of them actually occurring.

    One of the big issues in NSW was insurance on these "placements". Public Health facilities wouldn't let you step inside their unit on official business unless someone insured you. Problem is the hospital wasn't going to do it and privately you had no chance with any insurer.

    A suggestion to overcome these issues is to have the relevant Boards (Pod Reg/Med Reg) find the Podiatrist a mentor in a local GP. This should be a paid position (either funded by the Pod privately or subsidized via the Reg Board) in which the GP and Podiatrist can meet weekly to go through cases and pharm prescribed.

    Also will a Podiatrist who has passed all the requirements be able to provide the supervision? This also could circumvent issues once there is critical mass.

    Nat - you will have to wait until it is rolled out for a fair judgement of the system which has been put in place. I would like to believe it will work, however (like most things) on paper it looks excellent but in reality it will most likely be broken at the initial push.
     
  26. Tuckersm

    Tuckersm Well-Known Member

    This is a possiblity, but would still need the hospital sessions
    rejected along the way

    An endorsed podiatrist will be able to provide supervision, yes

    Paul, it is my opionion and not that of the Board, but based upon the Reg Board being a legislative body, not an advocatating or lobbying body, that is the A.Pod.As role, though I am sure the Board would support any such association activity. S4 was driven by the A.Pod.A. to achieve the legislative change with the support of the Reg Board. The Board then took over to comply with the Act, and that is really the Boards role. Hey but I could be wrong and the Board may ask DHS to support such a process.
     
  27. Paul Bowles

    Paul Bowles Well-Known Member

    Thanks for all the responses Stephen its much appreciated! The fact that Pods will be able to supervise should in time assist, however the fact that it needs to be in a hospital system is still of concern! We'll see how it plays out.
     
  28. Tuckersm

    Tuckersm Well-Known Member

    Just thought I would update you all.
    The Podiatrists Registration Board of Victoria endorsed the 1st 6 podiatrists to prescribe last week. 2 Surgeons, 4 hospital based (Diabetic Foot clinic), with 4 working at least part time in private practice.
    Not sure if anyone has written a script yet, or if they are waiting to be issued with the board produced prescription pad...
     
  29. Paul Bowles

    Paul Bowles Well-Known Member

    Nice work guys!!!
     
  30. Nat Smith

    Nat Smith Active Member

    Excellent! Congratulations to the first 6!
     
  31. tracyd123

    tracyd123 Member

    Hi I have recently started at a HRFS and currently work with a geriatrician twice a week. Are there any guidelines established as to what supervision should entail?
    Should I be seeking supervision from a prescribing podiatrist as well as the Doctor?

    Thanks

    Tracy
     
  32. Tuckersm

    Tuckersm Well-Known Member

    Tracey,

    If the geriatrician is happy to sign the supervisor agreement and provide the supervision that is fine ( a copy of this agreement should be forwarded to the board) You will find the relavent information on the Boards website. Also make sure you book into the LaTrobe update and the ALS course. Then once you have finished your 40 supervised sessions (and written up one case from each session using the boards or similar paperwork) as wellas the 40 dcase studies, evidence of your qualifications, completed supervisor report, certificate from LaTrobe Update course, ALS course and completion of the 40 case studies all need to be submitted to the board along with the currently $100 fee (Vic board upto June 30, National Board from July 1st)

    PS Good luck in your new role.
     
  33. trevor

    trevor Active Member

    Does a podiatry S4 script qualify for PBS benefits?
     
  34. Paul Bowles

    Paul Bowles Well-Known Member

    Not at the moment.
     
  35. Marco

    Marco Banned

    Hi the Australian podiatry board has said on there web site they have a list of courses that when done may qualify podiatrist to prescribe, however I can not seem to find anything as yet. Can anyone explaine the process

    I will asume it is going to be a long and hard journey, I currently have my practice in with 3 GPs and they are not at all happy about this :)

    Thanks guys
    Marco
     
  36. Craig Payne

    Craig Payne Moderator

    Articles:
    8
    Depends which state you are in and the S4 regulations in that state.
     
  37. Tuckersm

    Tuckersm Well-Known Member

    Currently the PBOA can only endorse podiatrists to prescribe in Victoria. This doesn't stop podiatrsist from other states becoming endorsed, but they could only prescribe when visiting Victoria.

    see their guidelines


    With the following courses approved

    And I think the Curtin Masters is also approved, or about to be.
     
  38. Paul Bowles

    Paul Bowles Well-Known Member

    Hi Stephen,

    I can see why this issue is becoming confusing when the Australian Podiatry Association (NSW and Canberra) sent out an email to its members on two separate occasions last week stating that:

    "Your association is pleased to announce that the NSW Government has amended the therapeutic goods act to allow Podiatrists to prescribe S4 drugs."

    There is no info from the PBOA on their website regarding this, no information for NSW Pods on how to apply and upon talking with them on the phone the PBOA suggested I email for information and they would pass it on to appropriate people. APodA(NSW) just defer to the PBOA site and also don't have any information.

    I would imagine that until the dust settles from national registration (what a massive job!), we won't know much more.
     
  39. Tuckersm

    Tuckersm Well-Known Member

    Paul,

    this is from the POISONS AND THERAPEUTIC GOODS ACT 1966 - SECT 17C

    Though no mention of which drugs, but still looks like NSW Pods can follow the Victorian model of being endorsed. And the Act was updated as of July1st, so may well have been a consequential ammendment in relation to the National Act.
     
  40. Paul Bowles

    Paul Bowles Well-Known Member

    Thanks Stephen,

    How do Pods in NSW actually go about becoming Board Registered for this? I think that is where most of the confusion actually is. i.e. fill out this form, submit these details, prove this etc....

    How is the PBOA handling this for Victorian Pods still applying?
     
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